title: Biopsychosocial typologies of pain in a cohort of patients with systemic sclerosis.
abstract: OBJECTIVE
  Despite being a common problem in systemic sclerosis (SSc; scleroderma), the extant literature on pain has primarily focused on biomedical correlates, or bivariate relationships with a few psychological characteristics. There is a need to investigate the more heuristic biopsychosocial model, which incorporates the simultaneous contributions of medical, psychological, and social variables in understanding pain.
  
  
  METHODS
  Patients with SSc (n = 333) received clinical examinations and completed self-report surveys at enrollment in the Genetics versus Environment in Scleroderma Outcome Study. Latent profile analysis was used to derive biopsychosocial profiles of patients using skin thickening, percent predicted forced vital lung capacity, perceived physical health, health worry, mental health, and social support. The profiles were examined in relation to pain and pain medication usage.
  
  
  RESULTS
  A 3-profile solution provided the best fit to the data. Based on the biopsychosocial indicators, the profiles were characterized as managing (n = 217), resilient (n = 86), and distressed (n = 30). Between-group differences for pain emerged, with the distressed group, whose disease was less severe than the resilient group, reporting the highest pain and the greatest utilization of pain medication.
  
  
  CONCLUSIONS
  Clinicians should consider biopsychosocial characteristics as contributing factors to the experience of pain in patients with SSc. Patients who are similar to those in the distressed profile may be at an increased risk for pain and would likely benefit from a referral to a behavioral health or other ancillary service provider for pain management, rather than relying solely on pharmacologic therapies.
authors.affiliation: San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology.
authors.forename: Erin L
authors.initials: EL
authors.lastname: Merz
authors.forename: Vanessa L
authors.initials: VL
authors.lastname: Malcarne
authors.forename: Shervin
authors.initials: S
authors.lastname: Assassi
authors.forename: Deepthi K
authors.initials: DK
authors.lastname: Nair
authors.forename: Tiffany A
authors.initials: TA
authors.lastname: Graham
authors.forename: Brayden P
authors.initials: BP
authors.lastname: Yellman
authors.forename: Rosa M
authors.initials: RM
authors.lastname: Estrada-Y-Martin
authors.forename: Maureen D
authors.initials: MD
authors.lastname: Mayes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy / Q000209:etiology* / Q000523:psychology*; D012595:Scleroderma, Systemic / Q000150:complications / Q000523:psychology*; D012959:Socioeconomic Factors; D055815:Young Adult
chemical_list: D000700:Analgesics